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HomeMy WebLinkAboutSUNNY VALLEY LT 21B l , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE NAME LOCATION Manufacturer ~ t~ ~--~r~ HOMEMADE: Well Well ~/~1 ]absorption a~? .~_ / Dwelling~x_~ Material Dwelling Foundation Material Nearest lot Ii? .~-/.~ · DISTANCE TO: No. of lines [ Length of each~ line~c~ / Total Iee, gt~_.o~li r~es_/_ ~,~ Trench----W~t~) inches Material beneath tile Top of tile to finish grade ~ ! Width Length Type of crib Crib diameter Well DISTANCE TO: DISTANCE TO: Depth Class OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS 7Z~ inches NO. OF BEDROOMS No. of compartments/ Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Total effective absorptlo area De th . PERMIT NO. /?~pth I Total effective absorption area /Building foundation Nearest lot llne Driller 1Distance to lot line PERMIT NO. ~L'~vC~lli2e 5' '?'~/'~/~ ~ic tank Absorption area(s) DATE IRev. 3/78) From -- Fro~ '~, Fr6m~ :. From~, ,From' :\ND P. O, BOX 272, ;-7' fORMATION: /,- -~. to '~' Ft. ~ to ~ Ft, to Ft. __ Ft. to__ __ _Ft. to __ Ft. to __ _Ft. to _Ft. to _Ft. to _Ft, to _Ft. to _Ft. to _Ft, to , Ft. Ft. Ft._ Ft._ Ft. Ft. Ft. , Ft. WELLS 99567 · TELEPHONE 688-2759 DEPTH OF WELL )RAW 8OWN m. GA~. PER HR ', KIND OF CASING From Ft. to Ft. From Ft. to Ft. to ' Ft._ to - Ft, Ft, to, . ,Ft to ~'!-~ 'Ft. __ Ft. Ft. to to ' "Ft. __ Ft. · Ft. to From ' tr Ft, to Ft.. -From' ,, Ft. to Ft._ From . Ft. to Ft, Fionl Ft. to Ft. -~ MIS~U:'INF( )RMATION: DRILLER'S NAME Permit Applicant: ~ ~2~ ~ Location: Legal Description: L jL! ~ ~uc~ ~ Type of Soil~sorption System Is: Trench:X.. Drainfield: Maximum Number of Bedrooms: .~ MUNICIPALITY OF ANCHORAGE Department(~ Health and Environmental Irotection · 825 ~ Street, Anchorage, AK. ~501 264'4720 * * * HANDWRITTEN PERMIT * * * #i~ WELL AND/~ ON-SITE SEWER PERMIT ~ ~Mailing Address: Phone Number: ~ [/~y Lot Size: Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is:' DEPTH /0 LENGTH ~--~ GRAVEL DEPTH ' ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /O'-D~> GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER ~1~ 1 9 8 3 * * * I certify that: (!) I ~am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if .~ include more that 3 b~drooms. esidence is remodeled to ~ Applicant \ Date- ~ ~ ~! ~ ~ U SWP/024 (1/81) <Permit %: 820689 ,January 31, 1983 TO: Permit Applicant Subject: Lot 21 Sunny Valley Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspec%ed the installation of the on-si~e sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerel~ Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 . , E:,EF'FIRTMENT ~..~2 FIE:FIL]-H F¢.~E:, E!'q',/I RONME]'.,Ff'E:IL. %,.:¢.!OT EFT i Z B..~E:.L.L_ ~ ~ ,,~E. ED~''~ ....... :~ :E -F'EE: ........ ~.~ ... ~,,~:,,~,..~ ,,~. F'ERMIT F,iO, ,' 82EIE;Fr;~ > T?F'E OF SOIl_ AE::BORPTZON S'¢:BTE}'I Z~B: 'TRENCH MR:q'r',! M NI i"IEER OF' E~E[,FF,-d"t'--'; = 4 .... OIL RFiTING <E;L::! F E,.BE ........ ::LE:(i ]*HE REE:!UiRED ~BIZE OF THE=,L~'-'-'l~ ....... ,':IEqFF.'pTI - '.~ o"COTc''', .... TO,: TFIE L. ENGTH [:,IMENrBIOF,I IS ]"FIE E_~:F~TH'" '" ,'IN FEEt .......... .) OF THE TR~.rIE.,~!'-' '" EE' 3,RR!F,F'(EL[',, THE DEPTH OF R TRENCH OR F'ZT iS THE DZ:BTRHE:E 8ETHEEN THE SURFF:ICE OF TF!E GROUND RND THE BOTTOM OF THE EXE:R',,,'F:iT!OH (IN FEET>. THERE IS i'.,IO 2;ET I,.!IE:,TH FOR TRENCHES. THE GRR'¢EL DEF'TH IS 'THE MINIMUM DEPTH OF GRR',,¢EL BETI,EEEN THE OUTFFILL. PIPE FIH[:, THE BOTTOM OF TFIE EXE:RVRTION <IN FEET). F'E:RMiT RF'E:'L.i~Z:Ri'.,IT H!:I5 THE RESF'OF,IS:[E~LJT'.r' TO iNF'ORM THiS [:'EF'RRTMEF,I'!" [:'LE'IHG THE I NSSTFiL. LFIT I E N 1 [,1_,[ EL T I Uh,:, OF' HEIi ':; R[:'JRC:EF~T TO ' ~" - n.~ .... F, I:, PR]F'F~'T'¢ FINE:, THE · ~_J1E,~R OF D ....... [.EI,ILE.:, THFIT THE ~.!E. LL HILL SERVE. BFICKFILLIF,IG OF FtF,!'¢_,':"-":'TC:i'~, ...,. ,_., HITHOUT F IF,!F!L. IN~:';F'ECT!ON RND RPF'ROVFIL~,~:'¢ 'TE~'~,I.:, [:,EF'F!R]'MENT H ILL 8E '.E JELfEF:T TEF RU.::,EL. U7 1 U[ ,!. MINIMUM DISTFINCE BETHEEN Fi HELL RND RN'¢ ON-:BITE SEHRGE Di'::,F'OSF!L S'~'S'I'EM fC~8 FEET FOR FI PRI',,,'RTE HELL OR &5Et TO 2C18 FEET FROM B PUBLIC HELL. DEPEF,!DING UPON THE TYPE OF F'OBLiC WELL.. H!NIMUM DtSTF!NCE FROM B F'RIVRTE HELL TO R F'RI'¢RTE SEE!ER LINE !:5 25 FEET RF,ID TO R COIdhlUNIT'T' SEI4ER LINE IE; 75 FEE]". HELL. i_.OGL5 FIRE REg!UIRED F~N[:, MUST BE RETURNED TO THE DEPRRTMENT HI'THIN 2:E~ OF THE WELL COMF'LETION. OTHER REg!UIREMENT% MR'¢ RFPL.'¢. :BF'ECiFICRTIONS Bf.,l[:, CONSTRUCTION DIRGRRMS RVRIL. BSLE TO INSURE PROPER INSTI~L. LRTIOFL I CERTIFY t: I Rh'l FRHiLIRR !,,.IITH THE REQLIiREMENT'.'5 FOR ON--SITE SE!qERS E:II",E:, [4EL. L:B RS SET FORTH B'¢ 'THEE MUNICIPFILIT'¢ OF: FINCHORFIGE. 2: I ,[,,liLt_ !NE;TF:!LL THE ?r%TEM IN ,q. CCORDFINCE HI]"H THE COl}E:5. 3:: I UNDER'_:;TRND THFf'F 'THEE ON-SITE S;EHER S'¢:STEM h!R'.r' RE(;!UiRE E:NLRRGE!',IEF,iT ]:F' TF!E IVIUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1325 L. Street, Anchor,§e, Alaska 99501 264.4720 SOILS LOG - PERCOLATIQN ]'EST I~ SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 ra 7 8 9, 10- 11 14- 16- 17- 18- 20' COMMENTS flCove. I WAS GROUND WATER PER~LATION RATE ',~' ~, (minutes/inch} PERFORMED BY: CERrlFIEDBY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 2lB; Sunny Valley Subdivision Location (site address or directions) 9420 Westla~e Drive, Eagle River, Alaska Property owner Mailing address Lending agency Mailing address Glenn ©liver Day phone 11840 Toy Drive, Anchorage, Alaska 99515 NORWEgT MORT~.AGE Day phone ATTENTION: Lynn Pope 276-4250 Agent Address Day phone -, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature DHHS SIGNATURE ,/"/~-- Approved for Disapproved. 17034 Ea~ile River Loop Road No. 204 ~~) bedrooms. Phone Date Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a cour-tesy to purchasers of homes an d their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Bac~ MOA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~'r' '~-I r~ (~0~,.~ '~/pa..L.~_~ Parcel I.D. ,/~'~.-.~..-¢~-Z'/ ~ 2 A. WELL DATA Well type If A, B, or C, attach ADEC letter. Date completed i.~_\ ~ ~-'z~ Driller Cased to ~ O ~ ~ Casing height J Wires properly protected I¢~'N) Log present i~N) ~ Total depth \ \ ~:'~ ~:~ Sanitary seal t~/N) ~*/ ADEC water system number FROM WELL LOG Date of test Static water level Well flow Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ ~"°~"'/~.~o,,~-,0- ~ Nitrate Date of sample: '~- - \ L~ - c~ -7.... Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~' ,"~ ~ Cleanouts ~N) High water alarm (Y/~ Date of pumping Other bacteria S & S ENGINEERING 17034 Eagle ~ver Loop ~oa,4 Eagle River~ Alaska 99577 Compartments "2-- Depression (Y~) Alarm tested (Y/N) ~' ~' Pumper ~.12-. /---F~-~ $ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ c~¢, ~ ~ On adjacent lots \ c:'c~ ~ Foundation ~.~ 4- To property line ~ D Absorption field Surface water/drainage \ ~c~ ~''~ 72-026 (Rev. 7/91) Front Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA elec~ Manufacturer Manhole/Access (Y/N) ~ -- "Pump on" level at ~ level at -~'""'~'~'"'~ C y c I e s tested Surface water D. ABSORPTION FIELD DATA Date installed ~"-'-/--\ ~ ~;~% Length '~"~ '~ Width : "~ Total absorption area ~'~ L~,~ Depression over field (Y~J~ Results<J;~Z~il) [;;:~J~ Peroxide treatment (past 12 months) (Y/~ _ Soil rating \'"~o'~'/l~?-.- System type Gravel thickness L,'~ Total depth Cleanouts present ~)~N) ',{ ~ Date of adequacy test ¢r -I "1 -~1 7- -- for '1"~¢~=~¢'~ (-'-~,.~ ~ bedrooms ~zL~,c,¢. ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot \cc To building foundation On adjacent lots "~ ~'~' Surface water Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots / c~o ~''' Property line ~ ~ ~ ~' To existing or abandoned system on lot Cutbank ~ I,~. Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines $ & $ ENGINEERING 17034 Eaglr~ Rlve~' Loop Road No. 204 Signature Engineer's Name Date ite of this inspection. HAAFee$ /70'~ Date of Payment /n~ ~7.-~.~ ~ ~ ReceiptUumber ~-~,"'~ [~ "~Z) ~l'7~'"'~) 72-026 {Rev. 3/91) Back MOA 2~ Waiver Fee: $ Dale of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUlVLAN SERVICES ENVIRONMENTAL SERVICES DIVISION ON-SITE WASTEWATER DISPOSAL SYSTEM INSPECTION ENGINEER FIELD AUDIT DATE: LEGAL DESCRIPTION: EXCAVATOR: ' COMMENTS: AUDITOR: Property Owner /) ; ' I, Phone Buyer ~'-'C) Address ' (~'~ ~.~ ) ~ '~ Zip Code Lending InsBtution Phone . Zip Code Realty Co, & Agent Phone Addres~.¢;~f~s~ ' Zip Code Water Supply ~ Co~munity For wells drilled prior 1o that d~le, give well depth (attach log if available). Time Time Time Time Date Dale Date Date ~/~!/~_~.~ Inspector Inspector Inspector Inspector Field Notes: /'l "D.pt. 0f He;~lth ( ~'~PPROVEO BEDROO~S ( ) DISAPPROVED ( ) CON DITION~L APP~I~OVAL' DATE BY: Well to Tank Septic Tank Size